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<title>DigiPly - Elderly and Disabled Medicaid Waiver Program Case Management System</title>
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        <td><div align="center"><b>AUTHORIZED ACCESS ONLY</b><br>
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        <td>Enter your user name and password, and then click &quot;Sign In&quot; to
          access the Elderly &amp; Disabled Medicaid Waiver Program Case 
          Management System.</td>
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        <td><table width="70%" border="0" align="center" cellpadding="4" cellspacing="0">
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            <td width="100" nowrap="nowrap"><div align="right">User Name:</div></td>
            <td width="100%"><input type="text" name="textfield"></td>
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            <td><div align="right">Password:</div></td>
            <td><input type="password" name="textfield2"></td>
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            <td>&nbsp;</td>
            <td><input name="Submit" type="submit" id="Submit" value="Sign In"></td>
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            <td><font size="-2">&nbsp;</font></td>
            <td>Forgot password? <a href="#">Click here</a></td>
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            <td><font size="-2">&nbsp;</font></td>
            <td>Need sign-in credentials? <a href="#">Contact us</a></td>
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    <td><div align="right"><a href="http://www.digiply.com" target="_blank"><font size="-2">DigiPly</font></a>&nbsp;</div></td>
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